The Steps to Accident Handling: Wilderness First Aid

The following hub is for informational purposes only. It is not to be used without actual training in First Aid. For the most up-to-date and thorough information, get yourself certified in first aid. You could save someone’s life in doing so!

Imagine being out in the woods hiking with your friends. Suddenly, someone behind you screams out, as if in pain. You turn to look and see one of your buddies laying on the ground, ankle twisted out to the side. He seems to be suffering tremendously as his weight is pressing the joint into an awkward position. Would you know what to do?

The benefits of being trained in First Aid cannot be emphasized enough. For those who engage in outdoor activities knowing what to do in case of emergency, whether physical injury occurred or not could mean the difference between life or death.

First Aid means just that. You are on the scene offering initial help to someone who needs it. Sometimes when encountering a person who needs help you won’t have to do much: get them into a comfortable position and wait until they feel better. However, wouldn’t it be good to know how to handle any kind of emergency, especially out in the back country where the nearest help is hours away?

Besides being able to determine the extent and severity of an injury, first aid training will give someone the confidence to assess a scene for additional dangers, take appropriate measures to be sure no one else in hurt, and institute care to reduce the chance of loss of life or limb. The training will also ensure that you know how to evacuate an injured or ill person and how to achieve that end with minimal dangers to you or the group.

There are several steps that you will learn in handling emergencies in the out-of-doors. These steps will also serve you if you happen to be in an urban area and encounter one who needs first aid.

Photo credit: UP OA

Learning the steps

Step One: Take Control

The first step is to take control. That doesn’t mean that you are bounding onto a scene, boasting that you know first aid and then making things happen! Sometimes you might come upon a scene in which there is a person who is critically injured, grotesquely injured, or perhaps not breathing at all. It is a normal human function to react to something you are not used to, and if you don’t get control of yourself and your emotions you could easily be swept up in the stress of the situation and lose focus. It is also imperative to take control of those bystanders who could distract you from your goals. Be a leader, take control and save yourself and someone else.

Step Two: Assess the Scene

When you have control of yourself and those around you, approach the scene slowly and carefully. The idea is to get a sense of what might have happened and if there is any lingering danger. It is important to not increase the number of injured by allowing the current danger to exist. For example, remove the sharp object (i.e., axe) which produced the cut to the leg. Make sure that no one else will fall from the cliff above. Look for a mechanism of injury and question those around you. Did anyone see what happened? How many injured are there to treat? Once you have a sense of what you are dealing with, it is much easier to commence with the help you are trained to offer.

Step Three: Keep the Patient Alive

It may seem obvious, but when you are trained in first aid your main objective is to keep the person alive. Then, and only then can you address the injuries that the person might have sustained. There are essentially four parts to keeping the patient alive and are listed in alphabetical order to facilitate memory. Remember the A B C Ds and you can save a life.

A:

Awaken. If the person is unconscious, it is important to try to awaken them. This is achieved by yelling into their ear, and if that fails, trying to illicit a pain response to arouse them.

Airway. A person will speak if there is an open airway. If they are unconscious, you must provide an open airway and maintain it.

Ambulance. An unconscious person, breathing or not needs to have an ambulance sent for. In urban settings that is most easily achieved by making a phone call. In the outdoors, a person or two might need to be sent to the closest phone to contact emergency services.

B:

Breathing. An important function which can be checked by holding your face close to the person’s nose and mouth. Check for at least ten seconds to be sure the person is moving air. If not, you need to reposition the face to allow an open airway. Still not breathing? Then there is no…

C:

Circulation. If there is no breathing, there is no circulation of blood feeding the brain. At that point, the trained person would institute CPR, or cardiopulmonary resuscitation. This would continue until the ambulance arrives. This is not meant to make someone better, but keep blood pumping into the brain so that they don’t die.

D:

Drainage position. As long as CPR is being administered, the patient would remain on his back. However, if you happen upon an unconscious breathing person, putting them into what is called the drainage position allows fluid to exit the throat and mouth reducing the chance of inhaling or aspirating the fluid. In this position the patient is able to have their head tilted back to ensure an open airway until the ambulance arrives.

Deadly bleeding. The last of the steps in keeping the patient alive is checking the body for bleeding. An unnoticed laceration could lead to the body emptying itself of the blood supply, thereby causing death. No one likes to hear the term “deadly bleeding”, but it is a fact that a person can be injured to that extent. Check under waterproof clothing and check head to toe to be sure that bleeding won’t be the cause of this person’s life ending.

Step Four: Prevent Aggravation

You have found someone that needs help. Now after checking through your ABC and Ds, you realize that the person is awake, talking, not bleeding but still injured. This is the time to ensure that the person stays warm, dry, and as comfortable as possible for the scenario. Without moving them or having them moved, cover their body with jackets, clothing or a sleeping bag. Protect from the elements overhead by raising a tarp or plastic bag. Can you place a cold element on the injured site to reduce swelling and pain? Can you offer emotional support? Delegate to others in the group by having someone make some hot soup or something to drink. Be sure that those in the group have an important duty to perform so that they do not provide a distraction: you will soon be checking your patient to find out what injuries they have sustained.

Step Five: Detailed Physical Assessment

Now is the time to check head to toe for injuries, knowing that there may be more than one that you must deal with. In certain situations, it will be obvious that there could be a head or neck injury which you do not want to aggravate. It is imperative that the physical assessment commences with the injured in the position you found them in. Beginning with the head and neck and moving through the core, you can check them for broken bones or internal injuries. Those with Wilderness First Aid training are taught the details of the examination to provide the most complete assessment. After the core is checked, the limbs are examined. This step is important in finding out just what kind of injury you are dealing with. Whether it is a fracture ankle, dislocated shoulder or injury to the lungs, you will be able through a thorough exam to determine exactly what injuries the person has sustained.

Photo Credit: Expedition School

Step Six: Prevent Further Aggravation

In this step, you will provide more comfort for the patient. You may find that the injuries allow you to move the person into an optimal position in order to reduce shock. Also, you will be able to reduce a simple dislocation or provide traction to those fractures that would benefit from it. During this time, you would be sure that the group does not go wandering about, getting into trouble themselves. Delegating important tasks at this time cannot be stressed enough.

Step Seven: Record keeping

Imagine that the person you are treating hasn’t had a tetanus shot in over ten years.

How important might that knowledge be to a receiving physician at the hospital?

When keeping records of an injury or illness, you gather pertinent information that will give the treating doctor and anyone else who has an interest in your methodology a detailed documentation of what you’ve done and medical history of the patient, if they happen to lose consciousness.

Step Eight: Make a Plan

Your patient is breathing (yes!). You’ve done your medical assessment and found that he has broken his ankle (oh-no!). You have moved him into a position to reduce the likelihood of shock and of maximum comfort. You have detailed his medical history and have recorded important information about his status. Now is the time to decide what you are going to do. With proper first aid training, you will know how to splint a fracture, or at the very least immobilize the injury to avoid causing further harm. During step 8, you formulate your idea about how to deal with the injury, and also how you will get the injured out of the environment and to a medical facility. Because even the best laid plans often fail, you will decide contingencies in case one method is unsuccessful or you must deal with changing environmental conditions. You utilize the gear and people you have with you, and you make your plan.

Step Nine: Do it!

In step 9, you implement your plan. You gather resources and splint the leg, you get your group together to get the injured out. Now is the time to make it happen!

Step Ten: Emotional First Aid

An oft overlooked aspect of rescue, offering emotional support to the injured and also the bystanders is essential. The emotions that can flood a person’s existence when dealing with an emergency can have severe negative effects. You want to remain calm, offer words of support, make sure that everyone is not in an emotional downward spiral. It could take hours for your evacuation or it could take days. Your group depends on you, the trained first aid responder, to ensure that morale is high.

Do not underestimate the power of positive thought!

You now know the ten important steps in accident handling when dealing with an injury or illness out in the wilderness. The details of how each injury is detected and treated comes only with thorough and intense training. As you may infer, proper training could mean the difference between life and death for those who have sustained injuries or illness. The importance of such training cannot be stressed enough. Do yourself and your fellow humans a favor, and get trained in first aid. If you frequent the out of doors for recreational activities, training in Wilderness First Aid is invaluable.

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